Antenatal and Post-natal management

Pregnancy is the most wondrous and beautiful time of a woman’s life… This statement was definitely written by a bloke, or a woman who’d never been pregnant!

While it’s true that the experience of growing a baby inside you, and then becoming a mother to an infant is amazing, it also tends to cause the poor woman to suffer some indignities of a physical kind. Stretch marks, weight gain, back pain, pelvic instability, urinary frequency and incontinence, sore breasts, neck pain, vomiting, swollen ankles, carpal tunnel syndrome . . . .

Fortunately, most of these things are temporary and will resolve fully once the baby has been born, and the mum has the chance to get back into normal life and exercise. However, some of the problems such as pelvic instability and back pain can be severely uncomfortable, to the point of being unable to walk, sit or stand. Physiotherapists and Remedial Massage/Myotherapists can be of great assistance during this time, to reduce muscular spasm, correct pelvic joint alignment, provide support with taping or bracing and give some “pregnancy-stage-appropriate” exercises to maintain muscle length, strength, and reduce pain. Around the start of the third trimester (26 weeks) the body starts to increase production of a hormone called Relaxin, which has the role of loosening the ligaments in the pelvis to allow a wider, more pelvic angle, and therefore birth canal. Unfortunately, there is no way a hormone can specifically target one joint (pubic symphysis) and so we have loosening and instability of sacroiliac joints (at the base of the lower back), hips, fingers, etc. This, coupled with ever increasing stretch and load on the normally supportive pelvic floor and inner abdominal muscles (as the baby grows) produces a real primary instability in the pelvis.

Separation (diastasis) of the abdominal muscles, too, can be a real problem for some women. While very little can be done about these during pregnancy (since the baby just keeps growing) we can support with compression garments such as tubular compression stocking, or the pregnancy compression shorts. Following the birth, assessment of the degree of separation is required to determine whether surgical intervention may be required, but in the largest majority of cases this can be completely fixed with exercises for the inner abdominal muscles and supportive garments.

Just as the back pain from pelvic instability gets better after birth, many women suffer neck, upper back and headache pain, from the extreme head forward position of nursing. It’s hard not to look at the cute little things! Coaching of more appropriate positioning with pillows, reminders to look up and into the distance once latch-on, or bottle, is in place, and some treatment for the joint strain and muscular spasm can be amazingly relieving. Nursing is hard enough, you shouldn’t have to get neck pain from it too.

Lastly, almost all women who give birth, either C-section or naturally, will require some rehabilitation of pelvic floor muscles. This is usually noticed due to light bladder leakage with laughing, squatting, coughing etc after giving birth. This is completely reversible, but the quicker it is addressed, the better the outcome. It may be an uncomfortable topic to broach, but be reassured that it is exceedingly common, and best managed quickly.